IOTW 12-07-17

-23 yo M presents with RLQ abdominal pain
-CT abdomen with contrast ordered by primary team to r/o appy
-Upon further questioning, the pain is actually in RUQ as well
-Which CT should we order? With or without contrast??
-Let’s do an ultrasound!

What do you think?

Color Flow

There is no color flow, which means this is hydronephrosis!

Ultrasound Saves the Day!

The patient’s CT was changed to “without contrast” due to the likelihood of nephrolithiasis.
-Official CT read:
-Edematous right kidney with perinephric stranding. Mild right hydronephrosis caused by 2 mm stone that probably recently passed into the urinary bladder.
-2 mm nonobstructive stone in the upper pole of the right kidney.
-The patient’s ED course was altered by ultrasound!

Renal US Pearls

-Curvilinear probe
-Always do a full renal US exam, including right and left long and short views, and bladder long and short view
-Start with the unaffected side
-If you see a cyst, measure it and put on color flow
-Abdominal exams change- always do them serially!